Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk

Christine K Fox; Mark T Mackay; Michael M Dowling; Paola Pergami; Luigi Titomanlio; Gabrielle Deveber; SIPS Investigators

doi:10.1111/dmcn.13198

Prolonged or recurrent acute seizures after pediatric arterial ischemic stroke are associated with increasing epilepsy risk

Dev Med Child Neurol. 2017 Jan;59(1):38-44. doi: 10.1111/dmcn.13198. Epub 2016 Jul 16.

Authors

Christine K Fox^{1

2}, Mark T Mackay^{3

4}, Michael M Dowling^{5

6}, Paola Pergami⁷, Luigi Titomanlio⁸, Gabrielle Deveber⁹; SIPS Investigators

Collaborators

SIPS Investigators:
Adam Kirton, Abdalla Abdalla, Dimitrios Zafeiriou, Neil Friedman, Nana Tatishvili, Anneli Kolk, Jennifer Armstrong-Wells, Rebecca Ichord, Catherine Amlie-Lefond, Gordana Kovacevic, Marta Hernandez Chavez, Belinda Stojanovski, Kristin Guilliams, Jorina Elbers, Heather Fullerton, Susan Benedict, Patricia Plumb, Lori Jordan

Affiliations

¹ Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
² Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
³ Department of Neurology, Royal Children's Hospital, Melbourne, Vic., Australia.
⁴ Murdoch Children's Research Institute, Melbourne, Vic., Australia.
⁵ Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁶ Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
⁷ Department of Neurology, Children's National Medical Center, Washington, DC, USA.
⁸ Pediatric Migraine and Neurovascular Diseases Clinic, Robert Debrè Hospital, Paris, France.
⁹ Division of Neurology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

Abstract

Aim: To determine epilepsy risk factors after pediatric stroke.

Method: A cohort of children with arterial ischemic stroke (birth-18y) was enrolled at 21 centers and followed for 1 year. Acute seizures (≤7d after stroke) and active epilepsy (at least one unprovoked remote seizure plus maintenance anticonvulsant at 1y) were identified. Predictors were determined using logistic regression.

Results: Among 114 patients (28 neonates and 86 children) enrolled, 26 neonates (93%) and 32 children (37%) had an acute seizure. Acute seizures lasted longer than 5 minutes in 23 patients (40%) and were frequently recurrent: 33 (57%) had 2 to 10 seizures and 11 (19%) had more than 10. Among 109 patients with 1-year follow-up, 11 (10%) had active epilepsy. For each year younger, active epilepsy was 20% more likely (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.6-0.99, p=0.041). Prolonged or recurrent acute seizures also increased epilepsy risk. Each additional 10 minutes of the longest acute seizure increased epilepsy risk fivefold (OR 4.7, 95% CI 1.7-13). Patients with more than 10 acute seizures had a 30-fold increased epilepsy risk (OR 30, 95% CI 2.9-305).

Interpretation: Pediatric stroke survivors, especially younger children, have a high risk of epilepsy 1 year after stroke. Prolonged or recurrent acute seizures increase epilepsy risk in a dose-dependent manner.

Publication types

Multicenter Study

MeSH terms

Adolescent
Age Factors
Brain Ischemia / complications*
Child
Child, Preschool
Epilepsy / epidemiology*
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Online Systems
Recurrence
Risk Factors
Stroke / epidemiology*
Stroke / etiology*

Abstract

Publication types

MeSH terms

Grants and funding